From the Guidelines
For a 15-month-old child with macrocephaly, refer the child to a pediatric neurosurgeon, as they are the most appropriate specialist to evaluate and manage potential neurological and surgical implications associated with macrocephaly. According to the study by 1, a pediatric neurosurgeon is identified by board certification and has specialized training in the care of children with neurologic surgical problems, making them the best choice for referral. The child's head circumference should be documented on a growth chart to confirm it exceeds the 97th percentile or crosses two major percentile lines upward, as defined by 1.
The pediatric neurosurgeon will likely order imaging studies such as an MRI or CT scan to assess ventricular size and rule out hydrocephalus or other structural abnormalities, as suggested by 1. They may also recommend genetic testing if familial macrocephaly is suspected, as mentioned in 1. While waiting for the specialist appointment, continue routine developmental monitoring, and note any developmental concerns, neurological symptoms, or family history of large head size, as these factors help determine urgency.
It is essential to refer the child to a pediatric neurosurgeon rather than a general neurosurgeon, as they have the specialized training and expertise to care for children with neurologic surgical problems, including those with macrocephaly, as stated in 1. The pediatric neurosurgeon will be able to determine the most appropriate balance of care for both the child and the condition, and provide access to other regional pediatric and neurosurgical specialists if needed.
Key points to consider when referring the child to a pediatric neurosurgeon include:
- Documenting the child's head circumference on a growth chart to confirm macrocephaly
- Noting any developmental concerns, neurological symptoms, or family history of large head size
- Ordering imaging studies such as an MRI or CT scan to assess ventricular size and rule out hydrocephalus or other structural abnormalities
- Considering genetic testing if familial macrocephaly is suspected
- Continuing routine developmental monitoring while waiting for the specialist appointment.
From the Research
Referral for a 15-month-old child with macrocephaly
To determine the appropriate referral for a 15-month-old child with macrocephaly, consider the following:
- The child's macrocephaly may be due to benign enlargement of subarachnoid space (BESS) in infancy, which is the most common cause of macrocephaly 2.
- The American Academy of Pediatrics or the American College of Radiology do not provide imaging guidelines for macrocephaly, but studies suggest that intracranial imaging may not be necessary in children with no risk factors and a positive family history of macrocephaly 3.
- A pediatric neurologist or a specialist in pediatric emergency medicine may be suitable for referral, as they can evaluate the child's developmental milestones, perform a neurologic examination, and provide guidance on imaging studies and further management 4, 5.
Key considerations for referral
- The child's head circumference and growth pattern should be evaluated to determine if it is above 2 standard deviations above the mean for their age and sex.
- A detailed family and personal history, as well as a careful clinical evaluation, are crucial to reach the correct diagnosis 6, 5.
- Neuroimaging may be necessary to evaluate the child's condition, especially if there are risk factors such as developmental delay or neurological symptoms 3, 6.